Cardiac Symptoms in Women

Dear CCF MD, This is so called heart month, where every morning show and news station has a segment on Heart health, most focusing on the differece between cardiac symptoms among men and women. It seems to me I am hearing more and more tragic stories of women dying suddenly from heart attacks, most of them had sought medical attention weeks, days and even hours before collapsing and from what I have been told the majority of them were given a diagnosis of "stressed out".
I would like to know if something like an event recorder can detect changes in a rythmn strip if someone uses it during  an episode of subtle symptoms like back pain, shoulder pain, lightheadedness, or palpitations? Would changes related to ischemia be obvious at that time, or is a twelve lead the best method? The subtle symptoms are what most women usually feel(or that men do feel but usually ignore) and of course are not present during an office or ER visit. Thanks for any insight you may have.

[CCF-M.D.-RCJ]

NBCT,

Thanks for the post.

Q1:" ...if something like an event recorder can detect changes in a rythmn strip if someone uses it during an episode of subtle symptoms like back pain, shoulder pain, lightheadedness, or palpitations?"

Event recorders are good at detecting changes in rhythm, but bad at detecting changes that might indicate ischemia (def: inadequate blood flow).

Q2:"Would changes related to ischemia be obvious at that time, or is a twelve lead the best method?"

No, they would not be obvious on an event recorder, and in fact would be unlikely to be detected.

Q3:"The subtle symptoms are what most women usually feel(or that men do feel but usually ignore) and of course are not present during an office or ER visit. Thanks for any insight you may have."

The evidence supporting the contention that women usually feel atypical symptoms is not strong.  I think the best way to protect yourself is to be vigilant and persistent.  If you feel that something is not right, then pursue it.  Sometimes this means pushing (figuratively, please) your health care provider.

Hope that helps.

[Kimma]

i've posted here before, can never post a question for the docs, i had an ablation 11/02 for psvt, it cured the psvt but left me with this...

heres my symptoms:
-heart always pounding hard(not fast but hard)
-everytime i stand up i feel like im going to faint for about 30 seconds and my heart races up to 130
-for awhile i had sinus tach my heart almost never went below 100 even at rest, that lasted a few monthes, now its been going to 80bpm every once in while at nite but it feels like its pounding even harder than it normally does
-low blood pressue. it was 88/56 while sitting at docs office.
-panic attacks: i had one the other day where i felt my heart skip really hard then i felt a rush of cold blood to my head, heart started racing/pounding, i was shaking/trembling really bad. the racing heart and trembling lasted about an hour. i took a xanax it helped a little but i was still shaking.
-im fatigued and tired 24/7 which is really taking a huge toll on the quality of my life
-hands and feet always cold
-several times a day heart feels like its quivering but pulse feels fine.
-occasional mild chest ache over heart lasting only a few minutes, rate it on a 1-10 scale it would be a 3.
-constant heaviness at the bottom of my throat
-memory loss (dont know why?)
-lastly holter showed 754 pvc's  and 3.3 hrs of tachycardia in 24hrs
only test ive had since ablation is a holter monitor and blood tests. can anyone tell me whats going on with me?! dad has chronic genetic neurological disorder. mom;s dad died of heart attack age  38. i cant believe that what im feeling is normal. in 8 days im making a trip to cali to see the doctor that performed my ablation. sorry so long and thanks so much for reading. kim

[andi333]

I read an article, in a health magazine, about the issue of low blood volume and how it can contribute to panic attacks and  several of the other symptoms you describe. Do you have a drop in BP when you stand up? Are you drinking enough fluids and is your electrolyte balance normal?

I know this is a simple idea, but I thought it couldn't hurt to mention it.

[mbimom]

I can vouch for the fact that doctors treat women differnlty than men. I had complained for years that my  heart would be really fast and it would make me dizzy. My OLD doctor would tell me you are young and healthy I will give you a prescription for xanax so you can stop complaining about this. Well when it started happening so much and lasting real long one day I decided to go to the er and I was finally diagnosed with svt, my heart was beating at 220bpm. I tried beta blockers for a while and finally ended up having a succesful ablation.

During all this I found out that I also have bicuspid aortic valve with moderate regurfitation. I need to take antibiotics before dental work and I need yearly echos. My old doctor completely missed the boat on this.

I also have noticed on a recent trip to er for me after a fainting episode and my husband goin to er with chest pain about 2 weeks later that the way they handled him was completely different than the way they did me. So I think if you are a woman with chest pain you have to make sure you are taken seriouly. If you don't like the way one doc treats you find one that will listen.  That's just my 2 cents.

[Dracee322]

I know all too well how women are treated in the medical profession. Besides having my own cardiac issues among others, i work in an ER. I see people (especially women) get labled as "anxious" daily. I also hear stories from patients daily about how their diagnosis of Multiple Sclerosis or Lupus came after years of pushing and searching and not giving up!!! One women was finally diagnosed with MS by an ER physician after getting blown off by her own physician for a few years. He told her the symptoms were all "stress related" and "in her head". She was back in the ER last week because her legs went completely numb and she could barely walk. In light of all of the crazy flu bugs and people falling over dead I think it is only natural these days to get nervous when things don't feel right. In fact that is a common triage complaint: "I feel funny" or "I do not feel right". I think it is very important to be your own advocate and be assertive in your own health care until you are satisfied with the outcome. There are too many testing capacities to sit and wonder or take a blow off diagnosis. I know with my own body I am very careful. It is the only one I get and I am not about to let someone else blow me off. Physicians are VERY busy these days.......maybe for our own good. (Nothing personal, just observation)

[NBCT]

I hope everyone takes the advice of the MD for the need to be vigilant and persistant when it comes to your health. There are excellent doctors out there with the right approach who will give or find the answers to a medical issue and offer peace of mind that every patient deserves.(This forum has truly caring MDs and commentors offering the best advice about heart health issues that naturally scare anyone).
I know loud and clear the treatment that most women recieve when presenting with the vague complaint "I don't feel well", I experienced it when first having symptoms of irregular heartbeats with my primary MD who I did not see in twelve years ptior to that visit. He bluntly said, "you are obviously a stressed out Mom and nurse and probably a type A personality, I can order a med. that will help" The urge to tell him off was great, but then I would be stressed out after. I did find an excellent female cardio. MD and the peace of mind I needed.
Just yesterday I heard of a Mom from my daughters school who did not feel well, went to seven different doctors in seven months, each one going with the theory she is overdoing herself(assuming she had pneumonia without a chest xray, maybe you should quit your job etc.) the eighth doctor did a workup and she was diagnosed Friday with stage three lymphoma. I live in a small state with a well reknowned University and large teaching hospital with the same name thirty minutes away....many dropped the ball on that one!!!

[andi333]

Sorry, but I read the article a couple years ago and I don't remember the source. I've done a lot of reading about anxiety disorders because I, myself, started having panic attacks almost ten years ago - when I was 27. I had a very difficult time for a couple years back then, but now I'm doing great and I can't even remember the last time I had a panic attack. I do still tend to be anxious about health issues - which is what brought me to this site. I've been trying to get on to ask a question. Take care and best wishes.

[starion]

Orthostatic Intolerance

I would suggest you ask your doctor about Orthostatic Intolerance "OI" (sometimes using this name may "ring a few bells").  This is where your heart rate greatly increases (often 30+ beats) over lying or sitting when you stand up.  My son has OI & we believe I do as well.  Initially my cardiologist kept telling me I don't have OI, but we have finally agreed I actually probably DO have it.  Since I'm not having disabling symtpoms, I'm OK & we're continuing to monitor & repeating a 24-hour holter monitoring test to see whether the meds I'm taking for my asthma/emphysema are contributing to my tachycardia (though we don't think so).

My doctors also did not believe I needed to see a cardiologist, though my heart rate has been 100s-110s while sitting for the past 6 months or so.  They kept insisting it was just my meds.  My cardiologist & I are glad I decided to see a cardiologist anyway.  He's been great at working with me & will work with my other docs as well.
Aloha,
Starion

[DEEZYRED]

I DESPERATELY NEED HELP. I JUST TURNED 50 ON FEB. 11 AND EVERY SINCE THAT DAY I HAVE BEEN HAVING THE MOST PECULIAR SYMPTOMS AND DON'T KNOW WHETHER THEY ARE DUE TO STRESS, PHYSICAL CONDITION, OR MY HEART. USUALLY IN THE MORNINGS I ONLY DRINK COFFE - NO BREAKFAST  - I DON'T THINK I NEED IT SINCE I AM QUITE OBESE AND NEED TO WATCH MY INTAKE. AS I SAID THESE SYMPTOMS STARTED ON FEB. 11, ALL OF A SUDDEN MY ARMS AND UPPER BODY STARTED TREMBLING AND MY HEAD FELT LIGHTHEADED AND THINGS STARTED SWIRLING IN MY HEAD. THIS LIGHTHEADED LASTED STRONGLY FOR A MINUTE OR SO BUT THE TREMORS AND SLIGHT PALPITATIONS IN MY HEART CONTINUED FOR A FEW MORE MINUTES. I TRIED LYING DOWN BUT IT DIDN'T HELP MUCH AT ALL. THE LIGHTHEADEDNESS TURNED INTO PERIODIC WAVES ACCOMPANIED BY SLIGHT NAUSEA. I DIDN'T FEEL ANY PAIN OR SWEATING OR DISCOMFORT IN MY CHEST. I ALSO HAD A SHOCK FEELING IN MY SKIN ACROSS MY SHOULDERS AND INTO MY ARMS. NEVER DID I START TO FEEL ANY PAIN. GRADUALLY IT SUBSIDED. THE FOLLOWING DAY I WAS FINE BUT THAT NIGHT, LATE, I HAD THE SAME CRAWLING SHOCK FEELING ACROSS MY UPPER SHOULDERS, I COULDN'T SLEEP THAT NIGHT. THE NEXT DAYS EVERY MORNING AFTER COFFEE, I FEEL THAT SLIGHT LIGHTHEADEDNESS AND NAUSEA UNTIL AFTER I EAT LUNCH AND THEN THE SYMPTOMS BASICALLY GO AWAY UNTIL I START TO GET HUNGRY AGAIN OR IF I GET VERY ANGRY. WHAT COULD THIS BE? I AM PRONED TO PANIC ATTACKS, BEEN TO THE EMERGENCY ROOM SEVERAL TIMES. ALSO I FORGOT TO SAY, OVER THE PAST YEAR, I HAVE BEEN THROUGH A DIVORCE, STARTED A NEW BUSINESS, GOT ENGAGED RECENTLY AND AM TAKING CARE OF MY ELDERLY MOTHER. CAN ANYONE GIVE ME SOME INSIGHT? PLEASE?

[janne]

Hey Hank, sorry I haven't written sooner, back to work full time, been really busy, not much time to play on the 'puter anymore. Hope things are good with you.  

NBCT and Docs

The doc here couldn't have given any better advice.  I am a 39 year old woman and with the exception of smoking (have quit), I had no risk factors. I had a heart attack last June (LAD blocked 90%). I was told that was "unusual".
I had a stent inserted, but shortly after (within the first month), I started experiencing the same symptoms as before my heart attack.  My G.P. and cardiologist were very supportive in that they did not dismiss me or leave me with the impression that it was all in my head.

I can't explain it exactly, but in my gut, I knew something was wrong. I was referred to one doctor after another, most thought there "might" be something wrong, but a few clearly left me with the impression that it was all in my head (in fact one told me to try maalox/tums and I'd feel better).   Again, I was told it was "unusual" to reblock so early.

I passed all tests, including a stress thallium, but a PET scan showed ischemia. My symptoms were not consistant and were not necessarily induced by activity.

I had been passed around to so many doctors, and although I was grateful they were taking the time to see me, I became so confused by their opinions that I found that I was second-guessing my gut instinct.  Towards the last month or so, I really started to believe it was all in my head and that I needed a psychiatrist or that I had just become a full blown whiner.

My symptoms were pressure in the chest, a choking sensation and a feeling of food stuck in my throat and chest.
The cardiologist who was to do my angioplasty said because some of my symptoms were so unusual or atypical, he was not sure it would get rid of them all (mainly the food in the throat thing and the choking feeling).
While he inflated the balloon I felt all of the symptoms exactly as I felt them on a day to day basis.  He said woman humbled him every day and he learned something new almost every angioplasty he did.
It ended up that my LAD was 90% blocked again. They inserted 2 medicated stents (one inside the first stent that I had put in after the heart attack) and one just above those stents.

I cannot believe how great I feel since I had it done! I was really starting to get scared that I would go through all of this and come out feeling just as crappy as I felt going in. But, all of the symptoms are gone, the pressure, the choking feeling, and the food caught in the throat feeling. I even notice when I am really angry that I no longer have any chest discomfort. I can only describe it as feeling like my lungs are expanding better and that my chest feels looser.
I am amazed at how good I actually feel and I now realize that I think my symptoms were a lot worse and the angina had a larger affect on my life than I had originally thought.  I still don't feel like I have as much energy as I always used to, but I think that's because of the beta blocker I'm taking.

Anyway, I am so glad for this forum and for the few doctors who supported me through all of this.  It feels so good to feel "normal" again and I will never doubt my gut instinct again.
Janne

[DEEZYRED]

SORRY I POSTED A COMMENT ON THE BOARD WHICH SHOULD HAVE BEEN A QUESTION.

[janne]

forgot to mention in my above post that one of the other things/symptoms I noticed was that when I did activities that required arm movements (usually above my head) like hanging laundry, and when I carried stuff (not really heavy, just a basket of laundry) up the stairs I also noticed an increase in my symptoms (pressure, choking, food caught in throat feeling etc.). There seemed to be more of a correlation with activities with my arms and angina than with my legs and angina. All of these symptoms are gone since I had the angioplasty...maybe I was just allergic to doing laundry haha
Janne

[NBCT]

I am so glad for you persistance paid off and I hope all or at least one of the doctors you had seen will learn to be more opened minded when listening to a female patients concerns!! Enjoy your new found health......and even the trips to the laundry room!!

[whelans5]

When I started to read your comment I thought "did I write this and not remember?"

I complained to my doctor for years about palpitations and being tired.  He told me if I said I wasn't tired he'd think something was wrong with me because I have 3 active children.  He passed the palpitations off as being stress.

I too finally said enough is enough and went to the ER and told the doc there that my doc wouldn't check anything out and I was scared.  So, he sent me to an internist who listened to my heart and said, "Did anyone ever tell you, you had a murmur?"  Then said it sounded as though I had MVP. So, he sent me for a holter monitor and an echocardiogram.  Well, I too have bicuspid aortic valve with regurgitation, but I don't know how much.  Once you see the internist (in Canada) you go back to your family doc for the results and my family doc said, "you're fine. you don't need antibiotics before dental work" and wouldn't prescribe any.  I get dental work done every 3 months.  My periodontist wouldn't do any work until I found out if I had regurgitation.  So, I called the internist's office and they said I had to be referred again, that was until I quoted my family doc who said "Dr......isn't up on his antibiotic use, you don't need any"  Well the internist was on the phone within seconds and told me I DID need antibiotics and that my dentist could write the prescription.

Bottom line, we know our bodies better than anyone and doctors are too quick to say stress when it comes to women.

I wonder if the gurgling feeling (like sucking up the last of liquid from a cup) I get sometimes in my heart area is regurgiation.  Do you ever feel that?

[mbimom]

Hi, I cann't say I have ever had a gurgling feeling. I do get a pain in the same spot of my chest that is really persistant and I am currently having dizzy spells (getting up or laying down and every time I look up).  I had a 24 haltor monitor done but my appt. for the results isn't till next wed. My cardiologist doesn't seem to have an answer for my pain. I did the whole round of doctors and tests for it (pulinary, primary,and gastro) everything came back normal. I am getting tired of doctors and am ready to just learn to live with the way I feel. If the halter comes back ok thats it for me.

[Mel22]

"It ended up that my LAD was 90%"

What's a LAD?


Thanks.

[nikl]

What causes the feeling of food being caught in throat?? I have heard of this also but always thought it might be due to reflux or something but I have read about this "feeling" from a couple of different woman who have had a heart attack and I had that similiar feeling like something stuck in throat last week only for 2 days but I have never had that before, so now of course I am scared!

[janne]

Hi nikl

Sorry, I can't tell you what causes the "food stuck in the throat thing".  I can tell you that I had it on a daily basis, but not all day. It seemed to come and go, sometimes related to exercise, often related to stress/anger, but sometimes when I was just sitting doing nothing. You can understand why the doctors weren't sure it was angina.
Although I can't say there was a consistent or predictable amount of angina with activity, I did notice that if I remained really quiet (physically) and had a non-stressful day, the symptoms were not, as a general rule, as bad.  
The food stuck in the throat thing was also always accompanied by the same feeling of food being caught between my breastbones.  Sometimes I could feel it between my shoulder blades.  It did not appear to be related to eating, although I tried stomach medications, just in case it was.   Sometimes it felt as if someone was squeezing my throat down to my chest area.  Sometimes it felt like I had gas stuck in my throat and down lower (similar to the feeling of drinking a coke too fast and an air bubble would get stuck).  This air bubble feeling would sometimes "grow" as if it were a balloon expanding in my chest towards my shoulders.  Nitro would help deflate the balloon feeling.
I hope the descriptions help a bit.  All I can say is that if "you" feel there is something wrong, get it checked.  It may be nothing, but maybe it isn't.
Take care and good luck.
Janne
p.s. by the way, nitro relieved or at least decreased all the symptoms

[zdresslerb]

DEEZZYRED:  i hope you have gone to a Dr. already. of course, you have many many things going on, so since i'm not a Dr., i will tell you what happened to me and why this sounds too familiar and why i am worried for you.  

first of all, you have many things going on that don't apply to me, so if any of the contribute to your symptom, it wouldn't surprise me or they could be irrelevant, but i'd take this seriously over blowing it off for sure!  your obesity and dizziness after coffee or after getting up suddenly, divorcing, getting engaged and other life stress are all things that could contribute, but aren't related to what happened to me.  

i am a 35 year old completely healthy woman with no history of anything related to the heart or anything else for that matter.  i've never been in the hospital, other than to have my daughter.  currently i am 20 weeks pregnant, but this occurred in my 15th week.  here's what happened:

i felt dizzy, kind of nauseated with the feeling of my heart pounding and it seemed hard to breathe.  the feeling started out with there being a visual change (not spots, but more like in my perpheral vision, thing started to darken), then it seemed to travel down my body and eventually felt like my thighs becoming warm.  the entire thing was probably a minute or less, but was very uncomfortable.  it hit me in waves, like labor contractions do, but not even close to being related to the feeling of a contraction (except my goal was to breathe).  the first time if felt this feeling, i was sitting right here, in my office chair, at my desk, doing someting online.  since i was dizzy and nauseated, i leaned over and put my head in-between my knees.  this happened a few times, and then while i was bent over like that, i passed out.  i didn't figure it out until afterwards - i was wondering what i was doing down on the ground... i got back up and my husband rushed in wondering what the noise he heard was.  i realized that i must have keeled over and my head hit the computer.  he insisted i had low blood sugar and insisted that i lie on the couch and eat a Snickers and "chill."  When i went to bed that night, the waves of this feeling continued to come over me and even woke me up from sleep.  i wondered if i was having a heart attack or if something was going on with my pregnancy.  

The next day i called my OB office, 2 dyas later, I saw a Dr. (not my regular OB), who without inspecting anything about me decided that i was dehydrated and need to drink more water.  that night at Safeway, i felt that dizzy feeling and was wondering if i should stop walking.  the next thing i know, i'm lying on the floor in the meat dept. and people are standing over me.  i was rushed to the ER only to find out i have been experiencing Third Degree Heart Block (also called Complete Heart Block).  the means that the electrical signal between the Atrium and the Ventricle was not happening, therefore the Ventricle wasn't getting the message to pump the blood through my body, causing my blood pressure to be so low, i passed out.  once the ER Dr. noticed what was happening, he suggested a pacemaker and once he did, it started happening over and over again because it was freaking me out.  (so, don't discount all your life stresses and things that can definitely affect your health!).  bottom line:  i got a temporary pacemaker that night and sat in the hospital with it all weekend until i could get a permanent on on Monday at another hospital.  no one knows why this happened to me or whether it is related to me being pregnant.  apparently i am very lucky to be alive.  i'm also lucky i wasn't driving when this happened and especially that my daughter wasn't with me.  a friend told me today that a friend of a friend of hers just lost his wife to the same exact thing and that they were attending the funeral today.  a 52 year old woman with no history got Heart Block and is now dead.  that story makes me feel even more lucky about my circumstances.  i am kind freaked about having a pacemaker, probably for the rest of my life, but now i realize just how amazing it is that i am even still here to have the opportunity to have the rest of my life.  

this all said, GO TO THE DOCTOR IMMEDIATELY!  i attempted to refuse the ambulance ride and might not have gone to the hospital if i hadn't been in a public place when this happened, so i'm telling you, this is not something to wait and see about- find out now!  they should be able to tell from an EKG.  i hope you read this.  good luck to you.

[zdresslerb]

dear nikl,
the "food stuck in the throat" feeling is how i first described heartburn before i knew what it was.  i had never had heartburn before i was pregnant with my daughter and i couldn't figure it out.  now i'm pregnant again, and have it as well.  lying down is the most awful thing with heartburn, so sometimes i have to sit up at night when it annoys me.  take some TUMS (they don't really seem to work for me though) or Rolaids or something.  you might want to go the the Dr. to see if it's a worse version like Acid Reflux or GERD which there are medications for... but if it's not more serious, it's probably heart burn.  good luck!